Introdução O papel das alterações hemodinâmicas sobre o remodelamento do ventrículo esquerdo tem sido pouco estudado, especialmente na hipertrofia cardíaca por sobrecarga de volume. A queda da pressão arterial sistêmica e o aumento da pressão de enchimento do ventrículo esquerdo afetam negativamente a pressão de perfusão miocárdica e podem, assim, prejudicar a perfusão subendocárdica, preferencialmente. As conseqüências para o remodelamento do ventrículo esquerdo ainda não foram determinadas. Objetivos Os objetivos do presente estudo foram investigar o papel da pressão de perfusão coronariana (PPC) no remodelamento subendocárdico e os possíveis efeitos sobre a função cardíaca em um modelo de fístula aorto-cava. Métodos Ratos machos Wistar, pesando 330-350 g, foram submetidos ao modelo de fístula aorto-cava (grupo FAC) ou à cirurgia fictícia - sham (grupo SH). Duas avaliações hemodinâmicas foram realizadas: hemodinâmica inicial, com uma semana de cirurgia e hemodinâmica final, com oito semanas de cirurgia. Duas regiões do ventrículo esquerdo foram examinadas: a região subendocárdica (SE) e a região não subendocárdica (não SE). O fluxo miocárdico foi determinado com microesferas coloridas na semana 1. A expressão e a atividade de metaloproteinase (MMP), o estresse oxidativo, os níveis de citocinas, a atividade de mieloperoxidase e a fração de volume do colágeno foram determinados na semana 8. A estrutura e a função cardíacas foram avaliadas com ecocardiografia realizada na semana 8. Resultados Comparado ao grupo SH, FAC apresentou PPC inicial (86+ - 3 mmHg vs. 52 + - 5 mmHg; P <0,0001) e PPC final (86+ - 2 mmHg vs. 54 + - 4 mmHg, P <0,0001) menores e +dP/dt (5917+ - 266 mmHg/s vs. 4511 + - 285 mmHg/s; P = 0,0021) e - dP/dt (5639 + - 396 mmHg/s vs. 4343 + - 274 mmHg/s; P = 0,0121) finais menores. Também, a fração de encurtamento (55,8 + - 1,2% vs. 45,1 + - 2,1%; P = 0,0014) e a espessura relativa de parede do ventrículo esquerdo (0,72 + - 0,02 vs. 0,58 + - 0,03; P = 0,0058) foram menores. Ainda em FAC, o fluxo miocárdico foi menor em SE (2,7 + - 0,5 mL/min/g) comparado a não SE (4,8 + - 0,8 mL/min/g) e também menor comparado a SE (6,7 + - 0,4 mL/min/g) e não SE (7,5 + - 0,5 mL/min/g) de SH. A expressão e a atividade da MMP-2 predominaram em SE de FAC, particularmente nos animais com PPC <60 mmHg. Aumento dos níveis de IL-1beta e IL-6 foram também predominantes em SE de FAC. Já a atividade da mieloperoxidase e os níveis de TNF-alfa e IL-10 foram comparáveis entre os grupos. Comparado a SH, FAC apresentou maior fração de volume do colágeno tanto em SE (1,1+ - 0,1% vs. 7,7 + - 0,4%; P <0,0001) quanto em não SE (1,0 + - 0,1% vs. 4,9 + - 0,3%, P <0,0001). Das variáveis hemodinâmicas, a análise multivariada demonstrou que a PPC inicial foi a única associada de forma independente com a fibrose SE (R2 = 0,76; P <0,0001), com a +dP/dt (R2= 0,55; P = 0,0004) e com a -dP/dt (R2= 0,91; P <0,0001). Houve correlação da PPC final com a expressão (R2 = 0,55; P <0,0001) e a atividade da MMP-2 (R2 = 0,88; P <0,0001) e da fibrose SE com a +dP/dt (R2 = 0,55; P = 0,0004) e com a -dP/dt (R2 = 0,85; P <0,0001). Conclusão Na fístula, a diminuição da PPC está associada a dano em SE, representado por isquemia, estresse oxidativo, aumento de citocinas e de MMP-2, com desenvolvimento de fibrose. O remodelamento de SE interfere negativamente na função do ventrículo esquerdo. / Introdution The role of hemodynamic changes in left ventricular remodeling has been poorly investigated, especially in the context of volume overload cardiac hypertrophy. Low diastolic blood pressure and high left ventricular filling pressure are expected to negatively affect coronary driving pressure and thereby put in jeopardy subendocardial perfusion, in particular. The consequences to global left ventricular remodeling remain undetermined. Objectives The aim of this study was to investigate the role of coronary driving pressure (CDP) in the development of subendocardial remodeling and the conceivable effects on cardiac function, using a rat model of aortocaval fistula. Methods Wistar rats weighting 330-350 g were submitted to aortocaval fistula (ACF group) or sham (SH group) operations. Two hemodynamic measurements were determined following surgery: initial, at week 1; and final, at week 8. Two distinct myocardial layers were examined: the subendocardium (SE) and the non-subendocardium (non SE). Myocardial blood flow was determined at week 1. Metalloproteinase expression and activity, oxidative stress, cytokine levels, myeloperoxidase activity, and fibrosis deposition were assessed at week 8. Cardiac structure and function were determined by means of echocardiography at week 8. Results Compared with SH, ACF showed lower initial (86 + - 3 mmHg vs. 52 + - 5 mmHg; P <0.0001) and final (86+ - 2 mmHg vs. 54 + - 4 mmHg, P <0.0001) CDP and lower final +dP/dt (5917 + - 266 mmHg/s vs. 4511+ - 285 mmHg/s; P = 0.0021) and -dP/dt (5639?396 mmHg/s vs. 4343 + - 274 mmHg/s; P = 0.0121). Left ventricular fractional shortening (55.8 + - 1.2% vs. 45.1+ - 2.1%; P = 0.0014) and relative wall thickness were also lower (0.72 + - 0.02 vs. 0.58 + - 0.03; P = 0.0058). ACF showed lower myocardial blood flow in SE (2.7 + - 0.5 mL/min/g) as compared with non SE (4.8 + - 0.8 mL/min/g) and as compared with both SE (6.7 + - 0.4 mL/min/g) and non SE (7.5 + - 0.5 mL/min/g) regions in SH. Metalloproteinase-2 expression and activity predominated in SE of ACF animals, particularly in those with CDP <60 mmHg. Increased levels of IL-6 and IL-1beta also predominated in SE of ACF. Otherwise, myeloperoxidase activity, and TNF-alfa and IL-10 levels were similar in both groups. Compared with SH, ACF showed higher collagen volume fraction in SE (1.1 + - 0.1% vs. 7.7 + - 0.4%; P <0.0001) and non SE (1.0 + - 0.1% vs. 4.9 + - 0.3%, P <0.0001) regions. Multivariate analyses disclosed initial CDP as the only hemodynamic parameter independently associated with SE fibrosis (R2 = 0.76; P <0.0001) and with +dP/dt (R2= 0.55; P = 0.0004) and -dP/dt (R2= 0.91; P <0.0001). Final CDP correlated with both the expression (R2 = 0.55; P <0.0001) and the activity of metalloproteinase-2 (R2 = 0.88; P <0.0001) and SE fibrosis correlated with both +dP/dt (R2 = 0.55; P = 0.0004) and -dP/dt (R2 = 0.85; P <0.0001). Conclusion Low coronary driving pressure early in the course of ACF is associated with SE damage characterized by ischemia, oxidative stress, increase in cytokines and MMP-2, the development of fibrosis and by this mechanism interferes negatively in left ventricular function.

O infarto agudo do miocárdio (IAM) é a principal causa de mortalidade mundial. O IAM é acompanhado de remodelamento cardíaco, caracterizado por alterações gênicas, moleculares e celulares, com consequentes alterações no tamanho, forma e função do coração, e resultante disfunção ventricular e insuficiência cardíaca. Evidências experimentais e clínicas indicam que a prevenção ou o tratamento do remodelamento cardíaco beneficiam a função ventricular. A LDE é uma nanopartícula lipídica, com estrutura semelhante à lipoproteína de baixa densidade (LDL). A LDE tem a capacidade de se concentrar em células com superexpressão de receptores de LDL, como em processos proliferativos e inflamatórios, sendo utilizada com um direcionador de fármacos a sítios específicos. Nosso laboratório demonstrou que o tratamento com metotrexato (MTX), um fármaco antiproliferativo e imunossupressor, associado à LDE reduziu acentuadamente as lesões ateroscleróticas na aorta de coelhos submetidos à dieta hipercolesterolêmica. Esses resultados nos levaram à hipótese de que a LDE-MTX possa ser utilizada para minimizar o processo inflamatório pós-IAM, determinante para o remodelamento cardíaco, e seus efeitos deletérios. O objetivo do trabalho foi investigar o efeito do tratamento da LDE-MTX sobre o remodelamento cardíaco em ratos submetidos ao IAM. Ratos machos Wistar (300-400g) foram submetidos ao modelo cirúrgico de IAM ou à cirurgia fictícia (SHAM). Os grupos foram divididos entre: SHAM (solução fisiológica), IAM-LDE, IAMMTXc (metotrexato comercial), IAM-LDE-MTX. Os animais foram tratados uma vez por semana na dose de 1 mg/kg intraperitonealmente, por 6 semanas. Após 24 horas do IAM e ao final do seguimento, foi realizado o ecocardiograma. O coração, o pulmão, o fígado e os rins foram coletados para obtenção do peso relativo dos órgãos. O tamanho do IAM foi estimado pela média dos tamanhos dos IAM externo e interno. A avaliação da necrose dos miócitos, processo inflamatório, diâmetro dos miócitos e fibrose miocárdica nas regiões subendocárdica (SE) e intersticial (INT) foi realizada na região remota ao IAM. Marcadores de estresse oxidativo, inflamação, fibrose, angiogênese e os receptores de lipoproteínas foram quantificados por PCR em tempo real. O tratamento com LDE-MTX diminuiu a dilatação do VE, hipertrofia cardíaca, volumes sistólicos e diastólicos, espessura do septo interventricular e da parede posterior e massa do VE, comparado aos grupos IAM-LDE e IAM-MTXc. Além disso, houve uma melhora de aproximadamente 40% da função sistólica do VE em relação aos demais grupos IAM. O tratamento com LDE-MTX não alterou a função diastólica. O peso relativo do coração e do pulmão foi menor no grupo IAM-LDE-MTX quando comparado ao IAM-LDE. Na histomorfometria, houve diminuição no tamanho do infarto no grupo IAM-LDE-MTX quando comparado com IAMLDE. A necrose, infiltrado inflamatório e fração de volume do colágeno nas regiões INT e SE foram menores no IAM-LDE-MTX em relação aos grupos IAM-LDE e IAM-MTXc, assim como o diâmetro dos miócitos. A expressão gênica dos marcadores de estresse oxidativo e fibrose foi menor no grupo IAM-LDE-MTX quando comparado ao grupo IAM-MTXc. Com relação à inflamação, o grupo IAM-LDE-MTX apresentou menor expressão do gene para TNF-alfa quando comparado aos grupos IAM-MTXc e SHAM. No que se refere ao receptor de lipoproteína, nos grupos IAM-LDE-MTX houve menor expressão do gene para receptor de lipoproteína de baixa densidade (LDLR) quando comparado ao grupo tratado com MTXc. Não foi observada toxicidade em nenhum grupo. Os resultados deste estudo indicam que o tratamento com LDE-MTX melhora significantemente a função cardíaca e atenua o remodelamento cardíaco em modelo experimental cirúrgico para IAM / Acute myocardial infarction (AMI) is the main cause of worldwide mortality. AMI is accompanied by cardiac remodeling, characterized by genetic, molecular and cellular alterations, with consequent changes in the size, shape and function of the heart, resulting in ventricular dysfunction and heart failure. Experimental and clinical evidence indicate that prevention or treatment of cardiac remodeling benefits the ventricular function. LDE is a lipid nanoparticle with a structure similar to low density lipoprotein (LDL). LDE has the ability to concentrate in cells with overexpression of LDL receptors, such as in proliferative and inflammatory processes, and is used with a drugtargeting agent at specific sites. Our laboratory demonstrated that the treatment with methotrexate (MTX), an antiproliferative and immunosuppressive drug, associated to LDE markedly reduced atherosclerotic lesions in aorta of rabbits submitted to the hypercholesterolemic diet. These results led us to the hypothesis that LDEMTX could be used to minimize the post-AMI inflammatory process, determinant for cardiac remodeling, and their deleterious effects. The aim of this study was to investigate the effect of LDE-MTX treatment on cardiac remodeling in rats submitted to AMI. Male Wistar rats (300-400g) were submitted to the surgical model of AMI or Sham surgery. The groups were divided into: SHAM (saline solution), AMI-LDE, AMI-MTXc (commercial methotrexate), AMI-LDE-MTX. The animals were treated once a week at a dose of 1 mg/kg intraperitoneally, for 6 weeks. After 24 hours of AMI and at the end of the follow-up, the echocardiogram was performed. The heart, lung, liver and kidneys were collected to obtain the relative weight of the organs. Infaction size was estimated by mean extern and intern size of IAM. Evaluation of myocyte necrosis, inflammatory process, myocyte diameter and myocardial fibrosis in the subendocardial (SE) and interstitial (INT) areas was performed in remote area from AMI. Markers of oxidative stress, inflammation, fibrosis, angiogenesis and lipoprotein receptors were quantified by quantitative real-time PCR. Treatment with LDE-MTX decreased LV dilation, cardiac hypertrophy, systolic and diastolic volumes, interventricular septum and posterior wall thickness and LV mass, compared to AMI-LDE and AMI-MTXc groups. In addition, there was an improvement of approximately 40% of LV systolic function compared to other AMI groups. Treatment with LDE-MTX did not alter diastolic function. The relative weight of the heart and lung were lower in the AMI-LDE-MTX group when compared to the AMI-LDE. In morphometry, infarct size decreased in the AMI-LDE-MTX group when compared to AMI-LDE. Necrosis, inflammatory infiltrate and collagen volume fraction in the INT and SE regions were lower in AMI-LDEMTX than in AMI-LDE and AMI-MTXc groups, as well as the myocyte diameter. The gene expression of oxidative stress and fibrosis markers were lower in the AMI-LDE-MTX group when compared to the AMI-MTXc. Regarding inflammation, the AMI-LDE-MTX group had lower expression of the TNF-alfa gene when compared to the AMI-MTXc group and the SHAM group. As regards the lipoprotein receptor, in the AMI-LDE-MTX there was lower expression of the gene for low-density lipoprotein (LDLR) receptor compared to MTXc treated animals. No toxicity was observed in any groups. The results of this study indicate that treatment with LDE-MTX significantly improves cardiac function and attenuates cardiac remodeling in an experimental surgical model for AMI

La Galanine est un peptide ubiquitaire de 29 acides aminés chez les mammifères (30 chez l'homme) qui contrôle de nombreuses fonctions biologiques: (I) secrétions endocrines (insuline, somatostatine, glucagon); (II) comportement (prise alimentaire, nociception, apprentissage, mémoire); (III) tonicité musculaire dans le tractus digestif. Ce peptide a particulièrement été étudié dans le système nerveux central où il joue un rôle dans l'évolution de certaines maladies neurodégénératives telles que les maladies de Parkinson et d'Alzheimer. La galanine agit en se fixant sur 3 récepteurs connus, GalR1-2-3 qui appartient à la grande famille des récepteurs couplés aux protéines G (GPCR). Bien que la Galanine et ses trois récepteurs soient fortement exprimés au niveau périphérique, leur rôle dans les effets périphériques et leur implication en pathologie ont été très peu étudié. L'objectif de mon travail de thèse a été d'identifier le rôle de la galanine dans le remodelage myocardique, qui constitue un déterminant majeur dans la progression de l'insuffisance cardiaque. Dans un premier temps, nous avons démontré que la galanine possède des propriétés anti-apoptotiques et anti-oxydantes in vitro dans les cardiomyocytes. En effet, le traitement de cellules par la galanine entraîne une diminution de l'apoptose et de la production de radicaux libres oxygénés en réponse à l'hypoxie. En accord avec ces effets bénéfiques au niveau cellulaire, les études in vivo réalisées dans un modèle d'ischémie-reperfusion cardiaque, ont montré que le traitement à la galanine dans la phase précoce de reperfusion réduit l'apoptose et la nécrose myocardique. De plus, nous avons confirmé in vivo l'importance de la galanine dans la défense contre le stress oxydant associé aux lésions mitochondriales post-ischémiques. Dans un deuxième temps, nous avons mis en évidence le rôle important de la galanine dans le contrôle de l'activité des fibroblastes cardiaques in vitro. Nous avons montré que la galanine inhibe des étapes clés d'activation de la cascade pro-fibrotique dans les fibroblastes cardiaques. Les propriétés anti-fibrotiques de la galanine ont également été confirmées in vivo dans un modèle de surcharge en pression par constriction aortique chez la souris. Dans ce modèle, nos résultats montrent que le traitement chronique à la galanine s'accompagne d'une amélioration de la fonction cardiaque. Ces données nous ont permis de démontrer que la galanine joue un rôle clé dans le remodelage cardiaque et de proposer la galanine comme un candidat potentiel dans le traitement de l'insuffisance cardiaque. / Galanin is an ubiquitous 29 amino acid peptide in mammals (30 in humans) that controls many biological functions: (I) endocrine secretions (insulin, somatostatin, glucagon); (II) behavior control (food intake, nociception, learning, memory, pain); (III) muscle tonicity in the digestive tract. This peptide has been particularly studied in the central nervous system where it plays a role in the evolution of neurodegenerative diseases such as Parkinson's and Alzheimer's. Although Galanin and its three receptors (GalR1, GalR2, GalR3) are strongly expressed at the peripheral level, their role in peripheral effects and their involvement in the pathology have been poorly studied. The objective of my thesis work was to identify the role of galanin in myocardial remodeling, which is a major determinant in the progression of heart failure. Firstly, we demonstrated that galanin has anti-apoptotic and anti-oxidant properties in vitro in cardiomyocytes. Indeed, the treatment of cells with galanin causes a dose-dependent decrease in apoptosis and reactive oxygen species in response to hypoxia. In line with these beneficial effects at the cellular level, using in vivo model of cardiac ischaemia-reperfusion we showed that galanin treatment reduces apoptosis and necrosis in the early phase of reperfusion. In addition, we confirmed in vivo the importance of galanin in the defense against oxidative stress associated with post-ischemic mitochondrial lesions. Secondly, we demonstrated the important role of galanin in controlling the activity of cardiac fibroblasts. Using in vitro models, we have shown that galanin inhibits activation of key steps of the pro-fibrotic cascade in cardiac fibroblasts. The anti-fibrotic properties of galanin were also confirmed in vivo in a mouse model of pressure overload-induced heart failure. This observation is accompanied by an improvement of cardiac function. These data reveal that galanin plays a key role in cardiac remodeling and suggest galanin as a potential candidate in the treatment of heart failure.

Cardiovascular disease, and myocardial infarction (MI) in particular, remains a major burden in the developed world today. In fact, the remodeling process, which follows the initial ischemic episode of MI, is a major determinant of heart failure. Although several key mechanistic pathways involving cell growth and death have been identified, there is limited knowledge surrounding the role of the innate immune response as a positive or negative regulator of cardiac remodeling. Recent data strongly support a role for key regulatory components within the toll-like receptor (TLR) family as potent modulators of cardiac remodeling post-MI. It has been demonstrated that targeted gene knockdown of TLR4, as well as downstream adaptor proteins and kinases, significantly improve cardiac function and overall survival. While the well-known NF-κB transcriptional factor that is downstream to TLR4 signaling has been linked to remodeling, there has been no evidence thus far describing a role of the parallel interferon regulatory factor-3 (IRF3) signaling cascade in any facet of this process. Several key findings suggest that IRFs contribute to both cell growth and apoptosis, thus providing an appealing, and novel target for interrogation. In this thesis I describe how IRF3 contributes to maladaptive remodeling post-MI. In my first set of experiments, I demonstrate that IRF3 is acutely upregulated within the cardiomyocyte following MI and that this response contributes to excessive apoptosis post-MI. A targeted deletion of the IRF3 gene enhances cardiac function, decreases infarct size, and improves survival following MI. In the second set of experiments I demonstrate that IRF3 attenuates angiogenesis at the ischemic border zone by upregulating the expression of thrombospondins. I have shown that IRF3 deficiency, which liberates endogenous anti-angiogenic signals, promotes angiogenesis following ischemic injury. These data suggest that IRF3 is a potent regulator of cardiac remodeling and may be an effective therapeutic target to ameliorate maladaptive cardiac repair post-MI.

A leading cause of morbidity and mortality in the developed world is cardiovascular disease (CVD). Like many other disease processes the etiology of CVD has origins in both genetic and environmental factors. These factors affect the development of the heart and vasculature and how they respond to physiological and pathological stress. Abnormal heart development can lead to cardiac pathologies that manifest in a shift from normal cardiac geometry and physiology to what is called pathological cardiac remodeling. Often though, pathological remodeling can result from cardiovascular stress even when heart development is normal. Growth factors are essential mediators of cardiac development and physiology and a good number of clinical and experimental studies have implicated growth factors and their signaling effectors as potential therapeutic targets for pathological cardiac remodeling. Of those is Fibroblast Growth Factor 2 (FGF2) which is a potent inducer of fibroblast and cardiomyocyte proliferation in vitro. FGF2 is made in high molecular weight and low molecular weight isoforms (Hi FGF2 and Lo FGF2, respectively). It has already been demonstrated that, in the context of the heart, FGF2 modulates cardiac hypertrophy, cardiac fibrosis and mediates protection against cardiac injury. However, the isoform specific role of FGF2 in cardiac development, physiology and pathological remodeling has not been disclosed, and in this dissertation I address the hypothesis that FGF2 has isoform-specific function in cardiac physiology and remodeling. To test this hypothesis I used mice that are either deficient in Hi FGF2 (Hi KO) or Lo FGF2 (Lo KO) and subjected them to echocardiographic analysis and isoproterenol (Iso) treatment and compared them to wildtype (WT) cohorts. At baseline echocardiographic measurements, female Lo KO hearts are smaller and present with increased peak E-wave velocity, a diminutive A wave, and shortened mitral-flow deceleration time consistent with a restricted filling pattern and myocardial stiffness. Conversely, male Lo KO hearts present with a lower E wave and a higher A-wave velocity and a prolonged isovolumic-relaxation time consistent with impaired left ventricular (LV) relaxation. Female Hi KO hearts display no significant deviation from WT, while male Hi KO hearts exhibit increased systolic function. Hence, a deficiency in Lo FGF2 results in a shift from normal diastolic parameters and geometric measurements which is gender specific. Conversely, a deficiency in Hi FGF2 produces a phenotype in male hearts only. Histological and gravimetric analysis of Lo KO and Hi KO hearts post-Iso treatment reveals that female Lo KO hearts remain smaller even though their cardiomyocytes are hypertrophied while female Hi KO hearts present with a blunted hypertrophic response indicating a hypoplastic myocardium. Male Lo KO hearts present with an exacerbated fibrotic response and increased alpha-smooth muscle actin protein expression while Hi KO hearts exhibit a resistance to the fibrotic response and an induction of atrial natriuretic factor protein expression. Thus, in female hearts Hi FGF2 mediate cardiac hypertrophy while in male hearts Lo FGF2 and Hi FGF2 display an antithetical role in cardiac fibrosis where Lo FGF2 is protective while Hi FGF2 is damaging. Hence, cardiac remodeling following catecholamine overactivation is modulated by FGF2 in isoform- and gender-specific manners. In conclusion, the results presented here provide novel evidence on the interaction of gender and endogenous FGF2 isoforms as modulators of cardiac development, physiology and remodeling. Lo FGF2 signaling is necessary in the male heart for normal myocardial relaxation and for amelioration of the fibrotic response induced by beta-adrenergic stress, while in female hearts Lo FGF2 is necessary for normal cardiac growth and normal myocardial compliance. Hi FGF2 is necessary only in female hearts for mediating the hypertrophic response. Hence, I demonstrate that Lo FGF2 and Hi FGF2 have non-redundant roles in cardiac physiology and remodeling which are gender-specific.

No description available.

Cardiovascular disease, and myocardial infarction (MI) in particular, remains a major burden in the developed world today. In fact, the remodeling process, which follows the initial ischemic episode of MI, is a major determinant of heart failure. Although several key mechanistic pathways involving cell growth and death have been identified, there is limited knowledge surrounding the role of the innate immune response as a positive or negative regulator of cardiac remodeling. Recent data strongly support a role for key regulatory components within the toll-like receptor (TLR) family as potent modulators of cardiac remodeling post-MI. It has been demonstrated that targeted gene knockdown of TLR4, as well as downstream adaptor proteins and kinases, significantly improve cardiac function and overall survival. While the well-known NF-κB transcriptional factor that is downstream to TLR4 signaling has been linked to remodeling, there has been no evidence thus far describing a role of the parallel interferon regulatory factor-3 (IRF3) signaling cascade in any facet of this process. Several key findings suggest that IRFs contribute to both cell growth and apoptosis, thus providing an appealing, and novel target for interrogation. In this thesis I describe how IRF3 contributes to maladaptive remodeling post-MI. In my first set of experiments, I demonstrate that IRF3 is acutely upregulated within the cardiomyocyte following MI and that this response contributes to excessive apoptosis post-MI. A targeted deletion of the IRF3 gene enhances cardiac function, decreases infarct size, and improves survival following MI. In the second set of experiments I demonstrate that IRF3 attenuates angiogenesis at the ischemic border zone by upregulating the expression of thrombospondins. I have shown that IRF3 deficiency, which liberates endogenous anti-angiogenic signals, promotes angiogenesis following ischemic injury. These data suggest that IRF3 is a potent regulator of cardiac remodeling and may be an effective therapeutic target to ameliorate maladaptive cardiac repair post-MI.

Resumo: A exposição à fumaça do cigarro resulta em remodelação cardíaca e está relacionada com disfunção ventricular. A atenuação da remodelação cardíaca pode ser importante para melhor prognóstico cardiovascular. A vitamina D (VD) tem se destacado por seu papel na função cardíaca e por atenuar a remodelação cardíaca em modelos de sobrecarga de pressão ou de volume. Objetivo: avaliar a influência da suplementação de VD sobre a remodelação cardíaca induzida pela exposição à fumaça do cigarro (EFC) em ratos, se a VD atua de forma dose dependente e verificar se esta atuação é por mecanismos anti-inflamatórios ou antioxidantes. Métodos: Ratos machos Wistar com 200 a 250g foram alocados em seis grupos: 1) VD0-NEFC, sem suplementação de VD e não EFC; 2) VD1-NEFC, suplementação de 1000 UI VD/kg de ração e não EFC (n=8); 3) VD3-NEFC, suplementação com 3000 UI VD/kg de ração e não EFC; 4) VD0-EFC, sem suplementação de VD e EFC; 5) VD1-EFC, suplementação de 1000 UI VD/kg de ração e EFC; 6) VD3-EFC, suplementação de 3000 UI VD/kg de ração e EFC. Após dois meses, os animais foram submetidos à ecocardiografia e eutanasiados para coleta de material biológico. Foram avaliados porcentagem de colágeno, área seccional do miócito (ASM), estresse oxidativo e marcadores inflamatórios no tecido cardíaco e dosagens sanguíneas de cálcio, fósforo e do metabólito 25-hidroxicolecalciferol. Os dados foram analisados por ANOVA de duas vias e apresentados em media ± erro-padrão. Foi utilizado teste de tendência (correlação de Spearman) para avaliar a resposta de dose dependência. Resultados: a EFC promoveu maior valor de parede posterior do ventrículo esquerdo (EFC = 1,38 ± 0,03; NEFC = 1,26 ± 0,03; p = 0,009), maior diâmetro diastólico do VE corrigido pela tíbia (EFC = 17,7 ± 0,20; NEFC = 17,0 ± 0,002; p = 0,033), maior massa do VE (MVE) ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Exposure to tobacco smoke (ETS) results in cardiac remodeling and it is associated with ventricular dysfunction. Attenuation of cardiac remodeling may be important for better cardiovascular prognosis. Vitamin D (VD) has become known for its role in cardiac function and VD supplementation attenuate cardiac remodeling in models of pressure or volume overload in previous studies. Objective: To evaluate the influence of VD supplementation on cardiac remodeling induced by ETS in rats and whether VD actions are dose-dependent and if these actions involve anti-inflammatory and antioxidant mechanisms. Methods: Male Wistar rats with 200 to 250g were allocated into six groups: 1) VD0- NETS, with no supplementation of VD and no ETS, 2)-VD1-NETS, supplementation with 1000 IU VD/kg of diet and no ETS (n = 8); 3) VD3-NETS, supplemented with 3000 IU VD/kg of diet and no ETS, 4) VD0-ETS, no supplementation of VD and ETS, 5)VD1-ETS, VD supplementation with 1000 IU/kg of diet and ETS, 6) VD3-ETS, VD supplementation of 3000 IU/kg of diet and ETS. After two months, the animals underwent echocardiography and euthanized for tissue collection. The collagen percentage, myocyte cross-sectional area (MCA), oxidative stress and inflammation biomarkers in cardiac tissue were determined. Blood levels of calcium, phosphorus and 25-hydroxycholecalciferol were also evaluated. Data were analyzed by two-way ANOVA and presented as mean ± standard error. Spearman correlation test was used to evaluate the dose dependent response. Results: ETS promoted greater value of left ventricular posterior wall (ETS = 1.38 ± 0.03; NETS = 1.26 ± 0.03, p = 0.009), LV diastolic diameter corrected by the tibia (ETS = 17.7 ± 0.20, 17.0 ± NETS = 0.002, p = 0.033), higher LV mass (LVM) (ETS = 603 ± 23; NETS = 509 ± 25, p = 0.007), higher LMV index (ETS = 1.8 ± 0.06; NETS = 1.5 ± 0.07, p = 0.004), increased MCA ... (Complete abstract click electronic access below) / Orientador: Sergio Alberto Rupp de Paiva / Coorientador: Leonardo Antonio Mamede Zornoff / Banca: Lilian Cuppari Valle / Banca: Daniela de Rezende Duarte Maksymczuk / Mestre

Orientador: Paula Schmidt Azevedo Gaiolla / Resumo: Introdução: A influência do ácido retinoico (AR) sobre o coração é bastante relevante, ocorrendo durante a embriogênese, diferenciação e desenvolvimento cardíaco. Estudos experimentais mostram que o AR pode induzir hipertrofia excêntrica com melhora da função cardíaca em coração de ratos sadios, e também reduzir a hipertrofia, modulando o sistema renina angiotensina aldosterona (SRAA), em animais hipertensos. Pouco se sabe sobre os efeitos do AR em coração de humanos. Pacientes portadores de acne fazem uso de um tipo de AR que é o 13- cis-AR, também chamado de isotretinoína e por isso possibilitam o estudo do papel do AR em humanos. Estudo prévio mostrou que com 2 meses de uso do 13-cis-AR houve remodelação cardíaca. Entretanto, não se sabe sobre os mecanismos ou se essas alterações são reversíveis. Objetivos: Portanto, os objetivos desse trabalho foram de comparar a avaliação morfofuncional cardíaca e variáveis do SRAA entre pacientes em uso de isotretinoína com um grupo controle. Adicionalmente, avaliar se as alterações são reversíveis em pacientes em uso de isotretinoína. Casuística e Métodos: Foram estudados 35 adolescentes e adultos jovens, com idade entre 14 e 23 anos, do sexo masculino, sendo 20 deles em uso de isotretinoína oral, na dose de 0,5 mg/kg/dia a 0,75 mg/kg/dia, acompanhados no ambulatório de dermatologia do Hospital das Clínicas da Faculdade de Medicina de Botucatu (FMBUNESP), aos 6 meses de tratamento. Os outros 15 pacientes foram convidados na comunidade ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: The influence of retinoic acid (RA) in the heart is very relevant, occurring during the embryogenesis, differentiation and cardiac development. Experimental studies shown that RA induces excentric hypertrophy, with improvement of cardiac function in heart of healthy rats. In addition, it was observed that RA regulates renin angiotensin aldosterone system (RAAS), a regulatory system involved in blood pressure, volume homeostasis and cardiac hypertrophy. There is a lack of information about the role of RA on cardiac remodeling in adult humans. Otherwise there are patients with Acne that uses 13- cis-RA, also called isotretinoin, and this population allow the investigation of cardiac remodeling and RA treatment. In fact, previously study shown that the use of 13-cis-RA, for acne, for 2 months induced cardiac remodeling, however, no one knows if these changes are persistent and reversible. Objectives: the objectives of these study is to compare the cardiac morphofunctional evaluation and RASS variables in patients using isotretinoin and in control group. Additionally, evaluate if these changes are reversible in isotretinoin group. Casuistic and Methods: Study1: 35 young men, between 14 to 23 years, 20 in use of 13-cis-RA, in the dose of 0,5 mg/kg/day to 0,75 mg/kg/day, from dermatology clinic of São Paulo State University (FMB-UNESP), at 6 months of treatment. The others 15 patients had mild acne only with topic treatment. Morphofunctional evaluation, tissular Doppler... (Complete abstract click electronic access below) / Doutor

Orientador: Carlos Roberto Padovani / Resumo: Em muitas situações, existe a necessidade de estudar o comportamento de alguma característica em uma mesma unidade amostral ao longo do tempo, dose acumulada de algum nutriente ou medicamento. Na prática, a estrutura dos dados dessa natureza geralmente estabelece comportamentos não lineares nos parâmetros de interesse, já que estes caracterizam melhor a realidade biológica pesquisada. Essa conjuntura é propícia ao estudo de remodelação cardíaca (RC) por sobrecarga pressórica em ratos submetidos a diferentes manobras sequenciais de cálcio. Como o comportamento da RC não está claramente estabelecido, o objetivo deste trabalho consiste em fazer um estudo comparativo sobre a performance de quatro modelos de curvas de crescimento em quatro grupos experimentais, considerando erros normais $\theta$ generalizado multivariado. Além disso, a modelagem dos dados envolve duas estruturas de covariância: a homocedástica com a presença de autocorrelação lag 1 e a heterocedástica multiplicativa. No contexto metodológico, utiliza-se o procedimento de estimação por máxima verossimilhança com a aplicação da técnica de reamostragem bootstrap. Além disso, técnicas de simulações são implementadas para comprovação das propriedades metodológicas aplicadas. Para comparação entre os modelos, utilizam-se alguns avaliadores de qualidade de ajuste. Conclui-se, no presente estudo, que a estrutura homocedástica com autocorrelação lag 1 para os modelos Brody e de Von Bertalanffy, destacam-se por apresentar ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Many situations, there is a need to study the behavior of some characteristic in the same sample unit over time, accumulated dose of some nutrient or medication. In practice, the structure of data of this nature generally establishes non-linear behaviors in the parameters of interest, since these characterize better the biological reality researched. This situation is favorable to the study of cardiac remodeling (CR) by pressure overload in rats submitted to different sequential calcium maneuvers. As the behavior of CR is not clearly established, the objective of this work is to perform a comparative study on the performance of four models of growth curves in four experimental groups, considering normalized multivariate θ standard errors. In addition, the data modeling involves two covariance structures: the homocedastic with the presence of autocorrelation lag 1 and the multiplicative heterocedastic. In the methodological context, the procedure of estimation by maximum likelihood is used with the technique of bootstrap resampling. In addition, simulation techniques are implemented to prove the methodological properties applied. For the comparison between the models, some adjustment quality evaluators are used. It is concluded in the present study that the homocedastic structure with lag 1 autocorrelation for the Brody and Von Bertalanffy models stands out for presenting excellent estimates and good quality of adjustment of the maximum developed stress (TD) as a function of t... (Complete abstract click electronic access below) / Doutor